Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports Randomized Controlled Trial Clinical Trial
[Severe bradycardia and asystole with low dose sufentanil during induction with sevoflurane: a report of three cases].
In a randomized double blind clinical study using low doses of fentanyl or sufentanil during sevoflurane induction, we observed three cases of severe bradycardia, forcing us to discontinue the study. We wish to describe these three cases. ⋯ The addition of sufentanil, even at very low doses, during anesthesia induction with sevoflurane using a single breath technique, may be dangerous because of possible bradycardia and even asystole.
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Perioperative beta-blockade appears to reduce morbidity and mortality in non-cardiac surgery, and is recommended by published guidelines. This study explores the frequency of perioperative beta-blockade and identifies factors limiting its use. ⋯ Use of preoperative beta-blockade among suitable candidates appears to be approximately 40%. Anesthesiologists started preoperative beta-blockers infrequently even in patients without contraindications. These findings suggest that educating anesthesiologists about the perioperative use of beta-blockade may increase the use of this potentially beneficial strategy.
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This is the second of two reviews evaluating the management of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: diabetes mellitus; morbid obesity; the ex-premature infant; the child with an upper respiratory infection; malignant hyperthermia; and the use of monoamine oxidase inhibitors. ⋯ Ambulatory anesthesia can be performed in, and is being offered to, a variety of patients with significant coexistent disease. In many cases there is little evidence documenting the outcomes expected in such patients. Prospective observational and interventional trials are required to better define perioperative management.